Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 25278 | CA |
NPI | 1255571857 |
---|---|
Provider Name | Dr. Tony Tang |
First Address | Chino, CA 91710-5466 |
Second Address | Chino, CA 91710-5466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2009 |
Last Update Date | 23/02/2009 |